Oral Defense:A Comparative Study of Levels

of Pathological Gambling Among Methamphetamine Abusers and

Other Substance Abusers

(Troy Bruner, Argosy University, Seattle)

OVERVIEW

1. Conceptualization of the Study1. Conceptualization of the Study2. A Brief Literature Review2. A Brief Literature Review3. Research Methodology3. Research Methodology4. Data Collection4. Data Collection5. Results5. Results6. Discussion, Conclusions, Implications6. Discussion, Conclusions, Implications

Study Conceptualization

A brief explanation of background inspirationA brief explanation of background inspiration

Conceptualization of the StudyDescription of the Research ProblemDescription of the Research Problem

Comorbid PG and MA abuse is an understudied Comorbid PG and MA abuse is an understudied subjectsubject

Studies of general substance abusers and PG’s Studies of general substance abusers and PG’s tend not to differentiate MA abusers from other tend not to differentiate MA abusers from other groups of stimulant abusersgroups of stimulant abusers

Most studies of substance abusers and PG’s do not Most studies of substance abusers and PG’s do not include any appreciable number of MA abusers include any appreciable number of MA abusers

relative to the population sampledrelative to the population sampled

Description of the Research Problem (cont.)

Currently, the majority of state-funded CD Currently, the majority of state-funded CD programs do not assess for PG programs do not assess for PG

Treatment is difficult to obtain in both the Treatment is difficult to obtain in both the CD and MH systemsCD and MH systems

Any research showing SA and PG Any research showing SA and PG comorbidities strengthens the argument for comorbidities strengthens the argument for dual-diagnosis assessment and treatment dual-diagnosis assessment and treatment

Description of the Problem (cont.)

Treating one addiction, but not a subsequent Treating one addiction, but not a subsequent addiction, limits treatment effectivenessaddiction, limits treatment effectiveness

The economic costs of treating CD and PG The economic costs of treating CD and PG are substantialare substantial

Comorbidity as an Additional Risk Factor

Substance abusers are more likely to have a Substance abusers are more likely to have a mental health disorder and vice versamental health disorder and vice versa

Individuals with two or more disorders are Individuals with two or more disorders are more likely to experience homelessness, more likely to experience homelessness, suicide, incarceration, unemployment, and suicide, incarceration, unemployment, and medical problems medical problems

(Source: Hasin et al., 2006; Quello, Brady & Sonne, 2005; Maxwell, 2005; US Department of Health and Human (Source: Hasin et al., 2006; Quello, Brady & Sonne, 2005; Maxwell, 2005; US Department of Health and Human Services, 2002) Services, 2002)

Description of the Problem (cont.)MA abusers experience many problems more severely than other types of substance abusers

Co-occurring psychiatric DisordersCo-occurring psychiatric Disorders Impulsivity, e.g., risky sexual behavior, Impulsivity, e.g., risky sexual behavior,

aggressiveness, and criminal behavioraggressiveness, and criminal behavior Infectious diseasesInfectious diseases Suicide CompletionSuicide Completion

MA & PG Comorbidities Psychiatric: most commonly mood disorders with Psychiatric: most commonly mood disorders with

depression being most prevalent followed by bipolar depression being most prevalent followed by bipolar disorderdisorder The suicide risk for MA ranges from about 20%-40%The suicide risk for MA ranges from about 20%-40%

PGs also most commonly experience mood disordersPGs also most commonly experience mood disorders Petry’s review of several studies of PG’s showed rates Petry’s review of several studies of PG’s showed rates

of lifetime suicide attempts ranging from 13%-36.7% of lifetime suicide attempts ranging from 13%-36.7% for treatment seekers versus 2.3%-11.1% for non-for treatment seekers versus 2.3%-11.1% for non-gamblersgamblers

Comorbid suicide rates are unknownComorbid suicide rates are unknown Alcohol and nicotine are the most common drugs of choice Alcohol and nicotine are the most common drugs of choice

for both groupsfor both groups

Description of the Problem (cont.)

MA abusers who are PG’s may be particularly vulnerable due to the chemical properties of MA

It delivers a longer lasting high than most It delivers a longer lasting high than most stimulantsstimulants Substance abusers who are PG’s tend to gamble Substance abusers who are PG’s tend to gamble

while intoxicated while intoxicated Unlike straight amphetamine, MA is methylated Unlike straight amphetamine, MA is methylated

(more dissolvable and quickly absorbed)(more dissolvable and quickly absorbed) MA is often augmented by harmful chemicalsMA is often augmented by harmful chemicals

Development of Hypothesis

The prevalence of PG among MA abusers is The prevalence of PG among MA abusers is unknown and should be studiedunknown and should be studied

The population studied should include appreciable The population studied should include appreciable numbers of MA abusers relative to the total numbers of MA abusers relative to the total number of subjectsnumber of subjects

Preferably, the study should be specific to Preferably, the study should be specific to individuals receiving state-funded treatmentindividuals receiving state-funded treatment

The study should compare levels of PG among The study should compare levels of PG among MA abusers with other substance abusersMA abusers with other substance abusers

Formal Hypothesis

MA abusers will experience higher levels of MA abusers will experience higher levels of PG when compared to a combined group of PG when compared to a combined group of other substance abusers other substance abusers

Definition of Terms…

Methamphetamine abuserMethamphetamine abuserSubstance AbuserSubstance AbuserPathological GamblerPathological GamblerProblem (or transitional) gamblerProblem (or transitional) gambler

LITERATURE REVIEW

PrevalencesPrevalences ComorbiditiesComorbidities Population CharacteristicsPopulation Characteristics NeurobiologyNeurobiology Treatment EffectivenessTreatment Effectiveness

MA Prevalences Global prevalence of annual ATS use is 0.5% (335m) of Global prevalence of annual ATS use is 0.5% (335m) of

which 49% (164m) consists of MA consumption (Source: which 49% (164m) consists of MA consumption (Source: UNDOC, 2004) UNDOC, 2004)

National annual prevalence of 0.6% (1.8m) and lifetime National annual prevalence of 0.6% (1.8m) and lifetime prevalence of 4.9% (14.9m) (Source: SAMHSA, 2006d)prevalence of 4.9% (14.9m) (Source: SAMHSA, 2006d)

2003-06 statistics show an increasing annual prevalence of 2003-06 statistics show an increasing annual prevalence of 0.91-1.13% in the State of WA0.91-1.13% in the State of WA

Meth treatment admission in the State of WA have Meth treatment admission in the State of WA have doubled since the 1990’s increasing from 4,056 in 1998 to doubled since the 1990’s increasing from 4,056 in 1998 to 8,052 in 2004, but have leveled off in subsequent years8,052 in 2004, but have leveled off in subsequent years

PG Prevalences

Nationally: (lifetime problem or PG) 1.1%-Nationally: (lifetime problem or PG) 1.1%-1.5% (3.3m-4.6m) 1.5% (3.3m-4.6m) (Source: Shaffer, Hall & Bilt, 2006)(Source: Shaffer, Hall & Bilt, 2006)

State of Washington: (lifetime problem or State of Washington: (lifetime problem or PG) 5% (past year) 2.5% PG) 5% (past year) 2.5% (Source: Volberg & Moore, 1999).(Source: Volberg & Moore, 1999).

Considerations: type of gambling; Considerations: type of gambling; proximity to casinos; legal versus illegal; proximity to casinos; legal versus illegal; internet gamblinginternet gambling

Population Characteristics of MA abusers

Numerically, most MA abusers are CaucasiansNumerically, most MA abusers are Caucasians When weighted for proportional comparisons, When weighted for proportional comparisons,

Hawaiian Americans experience the highest levels, Hawaiian Americans experience the highest levels, followed by Native Americans followed by Native Americans

Males abuse MA more than females, but Males abuse MA more than females, but marginallymarginally

MA abuse tends to be a more rural than urban MA abuse tends to be a more rural than urban phenomenon, but this is changingphenomenon, but this is changing

Methamphetamine Use in Past Year among Persons Aged 12 or Older, by Race/Ethnicity: 2002, 2003, and 2004Source: SAMHSA, 2005. For confirmatory research see: Windslow, Voorhees & Pehl, 2007

                                                                                                                   

    

Source: SAMHSA, 2006a

Treatment Data Most referrals for MA treatment come from Most referrals for MA treatment come from

the criminal justice systemthe criminal justice system Treatment tends to be standardizedTreatment tends to be standardized

Most PG’s in treatment were self-referredMost PG’s in treatment were self-referred There is a lack of uniformity in treatment modelsThere is a lack of uniformity in treatment models

Treatment effectiveness for both groups Treatment effectiveness for both groups increases with 12 step involvementincreases with 12 step involvement

CBT that stresses accountability and MI has CBT that stresses accountability and MI has shown some effectiveness for both groups shown some effectiveness for both groups

Source: SAMHSA, 2005Source: SAMHSA, 2005

Neurobiology: PG & MA Both addictive behaviors impact dopamine, Both addictive behaviors impact dopamine,

serotonin, and norepinephrine serotonin, and norepinephrine nuerotransmitter levels nuerotransmitter levels

““Gambling can induce effects that closely Gambling can induce effects that closely resemble a psychostimulant drug effect” resemble a psychostimulant drug effect” (Zack & Poulos, 2003)(Zack & Poulos, 2003)

Both groups demonstrate frontal lobe Both groups demonstrate frontal lobe impairmentimpairment

Both activites stimulate the prefrontal Both activites stimulate the prefrontal cortex and amygdalacortex and amygdala

Neurobiology of PG and MA

For MA and PG the primary neural pathway For MA and PG the primary neural pathway is the mesolimbic pathway (reward is the mesolimbic pathway (reward pathway) pathway)

The primary brain regions for this pathway The primary brain regions for this pathway include the amygdala, ventral tegmenta, include the amygdala, ventral tegmenta, nucelus accumben, and hippocampusnucelus accumben, and hippocampus

MA is neurologically destructiveMA is neurologically destructive

Behavioral Genetics & Heritability

Genes responsible for serotonic and Genes responsible for serotonic and dopaminergic expression have been linked dopaminergic expression have been linked to MA abuse and PG as well as other to MA abuse and PG as well as other addictionsaddictions

PG is associated with genes that mediate PG is associated with genes that mediate behavioral inhibitionbehavioral inhibition

There appears to be a genetic, heritable There appears to be a genetic, heritable predisposition for PGs predisposition for PGs

Independently conducted by: Community Independently conducted by: Community Detoxification ServicesDetoxification Services

Location: Spokane, WashingtonLocation: Spokane, Washington Investigator: Troy Bruner Investigator: Troy Bruner 109 Subjects109 Subjects Conducted over a period of 14 weeks Conducted over a period of 14 weeks

Research Overview & Methodology

Description of Instruments: SOGS & MAGS

Southern Oaks Gambling Scale Southern Oaks Gambling Scale Screens for lifetime PGScreens for lifetime PGAsks questions about type of gambling, Asks questions about type of gambling,

frequency, and amount spentfrequency, and amount spent Massachusetts Gambling Scale Massachusetts Gambling Scale

Detects presence of PG within last 12 monthsDetects presence of PG within last 12 monthsTwo scores. 1Two scores. 1stst Emphasizes psychosocial, Emphasizes psychosocial,

vocational, legal, and tolerance/withdrawal of vocational, legal, and tolerance/withdrawal of PGPG

22ndnd is based on is based on DSM DSM criteriacriteria

Description of Variables

IV: Type of substance abuseIV: Type of substance abuse

DV: SOGS Score: > 4 = PGDV: SOGS Score: > 4 = PG

MAGS 1 Score: > 2 = PGMAGS 1 Score: > 2 = PG

MAGS 2 Score: > 4 = PGMAGS 2 Score: > 4 = PG

Research Design

Descriptive-correlationalDescriptive-correlationalQuantitativeQuantitativeComparativeComparativeNon-experimentalNon-experimental

Data Collection & Population

Population characteristicsPopulation characteristicsInpatient adults screened for SAInpatient adults screened for SAConfounding variables addressed: MI, Confounding variables addressed: MI,

intoxication, vulnerability (withdrawal, intoxication, vulnerability (withdrawal, etc.) etc.)

Purposive sample, N =109Purposive sample, N =109

Results

Methamphetamine Abusers as a Percentage Methamphetamine Abusers as a Percentage of the Sampleof the Sample

FrequencyFrequency PercentagePercentage

MethMeth 3232 29.4 29.4

Non-methNon-meth 7777 70.6 70.6

TotalTotal 109109 100 100

Results: Meth vs. Non-Meth (cont.)

InstrumentInstrument TypeType NN MeanMean

SOGSSOGS Meth Meth 32 32 5.78 5.78

Non-MethNon-Meth 77 77 2.48 2.48

MAGS 1MAGS 1 Meth Meth 32 32 1.0603 1.0603

Non-MethNon-Meth 77 77 .0570 .0570

MAGS 2MAGS 2 Meth Meth 32 32 2.8125 2.8125

Non-MethNon-Meth 77 77 1.1558 1.1558

Results: Primary Dx Only

InstrumentInstrument TypeType NN MeanMean

SOGSSOGS Meth Meth 20 20 4.70 4.70

Non-MethNon-Meth 7777 2.48 2.48

MAGS 1MAGS 1 Meth Meth 20 20 .4315 .4315

Non-MethNon-Meth 7777 .0570 .0570

MAGS 2MAGS 2 Meth Meth 20 20 2.4250 2.4250

Non-MethNon-Meth 7777 1.1558 1.1558

Internal Consistency & Effect Size

Crobach’s Alpha shows an acceptable Crobach’s Alpha shows an acceptable internal consistency for all three internal consistency for all three instrumentsinstruments

Cohen’s D showed a moderate effect sizeCohen’s D showed a moderate effect sizeResponses were subjected to Pearson’s Responses were subjected to Pearson’s

Correlational Coefficient. The majority of Correlational Coefficient. The majority of items show a linear and consistent items show a linear and consistent relationshiprelationship

Data Summary The data confirmed the hypothesisThe data confirmed the hypothesis Per the SOGS results, of 32 MA abusers, 15 Per the SOGS results, of 32 MA abusers, 15

(46.9%) met criteria for PG in their lifetimes (46.9%) met criteria for PG in their lifetimes (versus 77 (24.7%) for non-MA abusers (versus 77 (24.7%) for non-MA abusers

MAGS 1 scores showed that 10 (31.25%) of MA MAGS 1 scores showed that 10 (31.25%) of MA abusers met criteria for PG compared to 7 (9%) for abusers met criteria for PG compared to 7 (9%) for other substance abusersother substance abusers

MAGS 2 revealed that 7 (29.1%) met MAGS 2 revealed that 7 (29.1%) met DSM-IVDSM-IV criteria for PG versus 7 (9.0%) for other SAcriteria for PG versus 7 (9.0%) for other SA

Aggregate SummaryOf all MA abusers, the instruments showed Of all MA abusers, the instruments showed

that 17 (53.1%) have met criteria for PG that 17 (53.1%) have met criteria for PG [SOGS & MAGS combined][SOGS & MAGS combined]

20 of 77 (25.9%) of the combined group of 20 of 77 (25.9%) of the combined group of other substance abusers met past or present other substance abusers met past or present criteria for PGcriteria for PG

For all groups combined (n=109) 33% have For all groups combined (n=109) 33% have met criteria for PGmet criteria for PG

Aggregate Summary (cont.)6 MA abusers had some history of problem 6 MA abusers had some history of problem

gambling without meeting criteria for PGgambling without meeting criteria for PG19 of the non-Meth group had some history 19 of the non-Meth group had some history

of problem gambling without PGof problem gambling without PGThus we can say that 71.8% of MA abusers Thus we can say that 71.8% of MA abusers

have likely been problem or PG’s.have likely been problem or PG’s.Of the non-Meth group, 50.6%Of the non-Meth group, 50.6%Combined, 62 (56.88%) have some history Combined, 62 (56.88%) have some history

of problem or PG of problem or PG

Secondary Analysis

The MAGS 2 did not appear to correlate The MAGS 2 did not appear to correlate with the MAGS 1 as well as the SOGS:with the MAGS 1 as well as the SOGS:

Every subject who met criteria for problem Every subject who met criteria for problem or PG in MAGS 1 also scored above or PG in MAGS 1 also scored above average on the SOGsaverage on the SOGs

Of the 37 who met criteria for PG on Of the 37 who met criteria for PG on MAGS 1 or SOGS, only 12 (32.4%) met MAGS 1 or SOGS, only 12 (32.4%) met criteria according to MAGS 2criteria according to MAGS 2

Discussion

The instruments showed that MA abusers The instruments showed that MA abusers experienced PG at levels higher that other experienced PG at levels higher that other substance abusers. substance abusers. (Petry, 2005 provides a good overview studies). (Petry, 2005 provides a good overview studies).

Overall, the instruments complimented each Overall, the instruments complimented each other, with some weakness on the MAGS 2 other, with some weakness on the MAGS 2 scoringscoring

Discussion (cont.)

Regarding gender, males scored higher than Regarding gender, males scored higher than females for all DV for both groupsfemales for all DV for both groups

Overall, both groups experienced much Overall, both groups experienced much higher levels of PG when compared with higher levels of PG when compared with the general population the general population

Conclusion

The hypothesis was confirmedThe hypothesis was confirmedThe presence of a problem has been The presence of a problem has been

confirmedconfirmedThe study implies that MA abusers, like The study implies that MA abusers, like

other substance abusers, may benefit from other substance abusers, may benefit from the assessment and treatment of PG the assessment and treatment of PG

Conclusions (cont.)What are the implication for future research?What are the implication for future research?Future studies should seek to confirm or Future studies should seek to confirm or

disconfirm the findings in other subject disconfirm the findings in other subject poolspools

MA abusers who are PG’s should be MA abusers who are PG’s should be studied to determine population studied to determine population characteristicscharacteristics

Eventually, there may be a need for Eventually, there may be a need for treatment specific to comorbid PG’s and treatment specific to comorbid PG’s and substance abuserssubstance abusers

Questions? Comments?

Observations?